- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.02 / $10.69 / $11.66
| Facility | | $8.02 | $10.69 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $7.60 / $60.94
| Professional | | $7.60 | $7.60 | $60.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $11.66 / $11.66
| Professional | | $6.67 | $11.66 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.81 / $18.22 / $21.34
| Professional | | $13.81 | $18.22 | $21.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $11.66 / $14.58
| Professional | | $9.72 | $11.66 | $14.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $11.66 / $16.48
| Professional | | $4.08 | $11.66 | $16.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.89 / $15.43 / $21.87
| Professional | | $10.89 | $15.43 | $21.87 |